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Patient Navigation-Process Mapping by Disease Site

By Tricia Strusowski, MS, RN

July 13, 2016

For this patient navigation blog post, let’s talk about a recent hot topic on ACCCExchange, the online discussion forum for ACCC members: At what point in the care continuum do you initiate navigation and support services?

Many cancer programs have a difficult time identifying when to initiate these services. Cancer programs know that staff are duplicating services, but they don’t want anything to fall through the cracks for patients and their families. At busy cancer programs, staff may be challenged to find the time to sit down and work out these details. Plus, getting all the healthcare professionals together for one more meeting can be a daunting task. Cancer programs want to provide the best experience for their patients while utilizing staff efficiently. One way to support this goal is by involved the entire team in creating a disease-site-specific process map to review the continuum of care; discuss staff roles and responsibilities; identify gaps, barriers, opportunities for improvement; and goals of care—all with the patient at the center of the discussion. Simply put: Increasing communication among the team and decreasing duplication for the patient.

Who Should Participate?

Ideally, the team participating in the disease-site mapping process should be representative of the offices and departments that will touch the patient during his or her journey. Keep in mind: You need to include the “worker bees,” the staff who really know the details of the patient flow. Let’s consider a head and neck cancer patient for example. In this instance, the following individuals should be invited to participate:

Surgery

Medical oncology

Radiation oncology

Inpatient unit case manager and/or discharge planner

Speech/swallowing therapist

Navigator

Social worker

Financial counselor

Behavioral health

Rehabilitation/Prehabilitation

Dental office

Others (We all know there is always someone we forget to invite!)

Plan your first session for 1.5 to 2 hours. Admittedly, this may be a challenge to schedule but it can be done, and the results will be amazing. Utilizing a large paper flowchart (i.e.,15 feet long x 4 feet wide), the group needs to talk through and record the process starting at the patient’s earliest point of entry. Each detail must be discussed, including length of time from one episode of care to the next, delays, gaps, and opportunities for improvement. Encourage participants share their goals during the discussion and write everything down!

Revisit & Revise

Process mapping exercises are not a one-and-done experience. It takes several meetings to review and revise the process map. There may be key individuals or a process that are missed in a previous session; no big deal, add them to the group. A great facilitator is key to keep the team on task and keep the discussion moving.

After the entire disease-site process is complete, overlay when you would like the navigator and the support staff to intervene. Remember: the goal is to provide the intervention as soon as possible, hopefully in a proactive manner so that you are “staying one step ahead of the patient.” Incorporate when you would like to initiate the distress screening process, identifying periods of highest distress for the patient/family.

The draft process map is also an excellent tool to share with the disease-site-specific healthcare providers who are often are not aware of all the details, delays, and opportunities to enhance the patient experience. Further, your process map will also be excellent tool for on-boarding new staff and for succession planning. Review and update your process map on a bi-yearly or annual basis.

Go Team!

I always share that the disease-site-specific team is like a football team; the better all the players understand everyone’s role and how to best support the patient and each other, the stronger the team will be. Every team always wants what is best for the patient. The mapping process is a valuable approach to not just identify gaps or delays in the care continuum, but to also then go the extra mile to identify “what is best for the patient.”